Optimal treatment for symptomatic talus Osteochondral Lesions (OCLs) where primary surgical techniques have failed has not been established. Recent advances have focussed on biological repair such as Autologous Chondrocyte Implantation (ACI) however funding for this treatment is limited. Stem cell therapy in the ankle has not been assessed. The purpose of this pilot study was to evaluate the safety and efficacy of stem cell therapy in the treatment of ankle OCLs.

The study was approved by the new procedures committee. Between January 2015 and December 2016, 26 patients, mean age of 36 years (range 16–58 years) with persisting disabling symptoms underwent Complete Cartilage Regeneration (CCR) using stem cells for failed primary treatment for ankle OCLs. Treatment involved iliac crest bone marrow aspiration, centrifugation to obtain bone marrow concentrate (BMC), and then injection of the BMC combined with hyaluronic acid into the OCL. Any necessary additional procedures, e.g. bone grafting or lateral ligament reconstruction were also undertaken. In 18 patients the lesion was on the medial talar dome, in 5 the lateral talar dome, 2 multiple, 1 tibial plafond. The Manchester-Oxford Foot Questionnaire (MOXFQ) was utilised to assess outcome.

Average pre-operative MOXFQ scores were Walking dimension −78, Pain dimension − 65, and Social dimension − 64.2. Average 3 month post-operative MOXFQ scores were Walking − 54.8, Pain − 35.4, Social − 38.9. Average 6 month post-operative MOXFQ scores were Walking − 34.4, Pain − 35.4, Social − 28. Two patients from the beginning of the series had AOFAS scores only which improved from an average of 55 pre-operatively to 76 post-operatively. No early complications were noted.

We conclude that CCR treatment is a safe treatment for talus OCLs in patients who have failed primary treatment. The procedure avoids two-stage surgery of ACI in some patients without large cysts. The early clinical outcome is favourable with no complications noted. Longer term follow-up is required.

Purpose: To determine current practice in knee Arthroplasty surgery for osteoarthritis in young patients for the population registered on the Trent and Wales Arthroplasty Database. Is there a ‘gold standard’? If there is what is it?

Method: The Trent Arthroplasty Audit Group collects prospective data on all knee Arthroplasty surgery performed in Trent Region and North and West Wales (population 6.2 million). In 2000/2001 7% of knee arthroplasties were performed on osteoarthritic patients aged 55 years or less. We analysed the database to reach the following results.

Results: In 2000/01 208 arthroplasties were performed in this group of patients. The youngest patient was 36 yrs. Seventy per cent of the patients were aged between 50 and 55 years. 114 were female. 27 had a unicompartmental knee replacement, mobile bearing in 25. Where the patient had a condylar knee replacent a mobile bearing design was implanted in 10 knees. A PCL sacrificing implant was used in 36% of cases. The patella was resurfaced in 31%. An uncemented prosthesis was used in 19 knees. An 8mm tibial insert was implanted in 32 cases and an insert of less than 10mm in a further eight cases. The surgery was performed by a Consultant in 65% of cases. A Consultant assisted in a further 14% of cases. The arthroplasty was the first surgical procedure to the knee in 38% of cases. The arthroplasty followed arthroscopic procedures in a further 41% of cases.

Conclusions: The surgeons of the Trent Arthroplasty Audit Group are offering knee Arthroplasty to their patients at an earlier stage. Surgeons don’t appear to change their surgical practice or choice of implant when operating on young osteoarthritic patients. Given that we have previously shown that 20% of these patients are disappointed by the pain relief and 38% by their level of function what should we recommend?